Concept Claim Solutions

Background

A homeowner submitted a claim under their home insurance policy after cracks developed internally and externally at the point where a conservatory adjoined the main house.

Despite accepting that subsidence had occurred, the insurer declined the claim. It asserted that the conservatory foundations were defective because they were not sufficiently deep for the prevailing ground conditions and adjacent planting. On this basis, the insurer relied on a policy exclusion for faulty design or workmanship and refused to progress the claim.

This decision caused the customer significant distress as they felt that the communication from the insurer was poor, with repeated calls and emails going unanswered, compounding frustration during an already challenging period.

The Challenges

The insurer relied on building standards guidance to argue that deeper foundations should have been installed when the conservatory was constructed. It compared the conservatory foundations with the deeper foundations of the main house and contended that, had the conservatory been built to a similar depth, the subsidence would not have occurred.

However, this reasoning did not withstand scrutiny. The relevant guidance did not prescribe a single “correct” foundation depth for the specific circumstances, and root growth was identified at depths greater than the conservatory foundations. This indicated that, even if the conservatory had been constructed to the same depth as the main house, subsidence could still have occurred due to the characteristics of the clay subsoil and seasonal ground movement.

Furthermore, the conservatory had performed satisfactorily for approximately 11 years without incident. This prolonged period of service undermined the assertion that defective design or workmanship was the operative cause of the damage.

How Concept Claim Solutions Helped

The dedicated Loss Assessor supported the customer by challenging the insurer’s decision on both technical and fairness grounds. This included:

• Refocusing the dispute on the proximate cause of damage (subsidence) rather than allowing reliance on a generic workmanship exclusion.
• Highlighting the conservatory’s long, trouble-free service life as evidence that defective design was not the operative cause of loss.
• Identifying and evidencing technical weaknesses in the insurer’s position, including the absence of any definitive standard for the foundation depth allegedly required.
• Supporting the customer with compiling their complaint to the Financial Ombudsman Service (FOS).

 
Outcome

The FOS determined that the insurer had not acted fairly in declining the claim. The insurer was directed to:

• Reconsider the claim under the remaining terms of the policy; and
• Pay compensation in recognition of the distress and inconvenience caused by the unfair handling of the claim.

As a result, the claim was able to proceed on a proper footing rather than being closed on the basis of an unsupported technical argument. The Loss Assessor subsequently coordinated approved contractors to undertake the necessary repairs.

For the customer, the issue extended beyond physical damage to the property. The prolonged dispute and poor communication had caused significant stress, particularly in light of existing health concerns. By challenging the insurer’s position and relieving the pressure on the customer, this ensured the claim was reconsidered fairly and progressed appropriately.